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Doctors Upset over Economic Credentialing Policies
A lawsuit currently being tried in Little Rock and a newspaper advertisement paid for by an anonymous group of doctors in Fort Smith question whether some hospitals are more concerned about their own financial success than about what’s best for patients. The Baptist Health Case Eleven doctors at Little Rock Cardiology Clinic, who share ownership of Arkansas Heart Hospital in Little Rock with Medcath Corp., of Charlotte, N.C., are challenging a policy enacted five years ago by Baptist Health. Arkansas Heart Hospital operates a 24-hour full-service emergency center, six catheterization labs and three heart operating suites. It is also a cardiac training center for the American Heart Association. The economic credentialing policy, which is also called an “economic conflict of interest,” denies doctors privileges at Baptist Health hospitals if they or any of their family members own a stake in a competing facility. Baptist Health is the state’s largest hospital system and the exclusive or preferred provider for Arkansas Blue Cross and Blue Shield, the state’s biggest health insurer. “Courts around the country have approved the right of hospitals to approve these types of policies,” said Robert L. “Skip” Henry III, Baptist Health’s attorney. “It’s our position that this is a reasonable decision on the part of the board of trustees.” The Arkansas Heart Hospital cardiologists say the policy interferes with the doctor-patient relationship and should be declared illegal and unenforceable. A temporary court order has allowed the physicians to maintain their privileges in the Baptist Health system while the case is ongoing. The plaintiffs did not return calls seeking comment. Testimony in the trial in Pulaski County Circuit Court began March 10 and ended March 20, and attorneys submitted findings of fact and post-trial briefs on April 25. Responses were due May 9. A ruling from Judge Collins Kilgore is not expected until early June and had not been announced as of press time. There is no jury in the trial. Russ Harrington, Baptist Health’s president and chief executive officer, testified that the hospital instituted the policy in 2003 in response to the opening of a specialty hospital, Arkansas Surgical Hospital. He said it was meant to protect the hospital because of fear that competitors would “cherry-pick” the most profitable patients, such as those needing cardiology services. Those profitable cases help to subsidize charity care or services that operate at a loss, such as neonatal intensive care units. “There was no evidence presented during trial that would convince anyone that cherry-picking was going on,” said David Wroten, executive vice president of the Arkansas Medical Society, which joined the lawsuit on the side of the cardiologists, along with the American Medical Association. “We do not join lawsuits lightly,” Wroten said. “This case has implications for a lot of people.” He said that while these types of policies do exist elsewhere, Baptist’s is so broad that, “its effects are almost unbelievable,” explaining that even if a distant relative of a physician owns a stake in a hospital in a city three hours away from Little Rock, that physician would not be allowed privileges at Baptist Health Medical Center. “This policy interferes with the doctor/patient relationship,” Wroten said. He added that patients may choose treatment at a particular hospital as a personal preference or because of insurance requirements. “Denying clinical privileges to physicians based upon purely economic factors is anti-competitive and punitive,” Robert Mills, media outreach coordinator of the American Medical Association, wrote in an e-mail to the Medical News of Arkansas. “Since the purpose of credentialing physicians is to assure a high standard of care, the primary factor for consideration should be competency, not economic factors unrelated to quality.” He added, “Economic policies that restrict physician credentialing are really intended to eliminate patient referrals to other hospitals or outpatient facilities that may be more convenient, cost effective or clinically appropriate for patients.” St. Vincent Health System, Baptist Health’s main competition in Little Rock, does not practice economic credentialing. “In the event that a court approves economic credentialing, we see no reason at present to change our current practice,” the hospital said in a prepared statement. “St. Vincent credentials physicians based on nationally accepted quality standards.” The policy has spawned another lawsuit that is pending, an antitrust case brought by the cardiology clinic that is scheduled to begin the week of Nov. 3 at the U.S. District Court at Little Rock. A similar lawsuit filed against Baptist Health Medical Center in April 2005 by Janet Cathey, a gynecologist in Little Rock, was settled, and Cathey’s privileges have been restored. Cathey was denied privileges after her husband, neurosurgeon Steven Cathey, joined other doctors in opening a specialty surgical clinic. Cathey argued that she would not be referring gynecological patients to a neurosurgery hospital, and because most of her more than 4,000 patients are enrolled in Blue Cross health plans, not being able to admit patients to Baptist Health Medical Center or perform procedures there would destroy her practice and interfere with patient choice. Steven Cathey has since sold his share of the clinic. Wroten said that no evidence was produced during the current trial to prove that Baptist Health had lost money to competing hospitals, but Baptist’s attorney maintains that Baptist Health has the right to protect itself financially. “The doctors have a choice,” Henry said. “They can choose to take profits and own a competing hospital or they can have privileges at Baptist.” No matter what the judge rules in this case, the issue will likely not be settled for some time. “There will probably be an appeal, either way,” Henry said. “It will probably be another 18 months to two years before it’s over.” Pointed Questions in Fort Smith Meanwhile, anonymous doctors in Fort Smith published a half-page advertisement in the April 27 edition of the Fort Smith Times Record questioning several policies of the St. Edward Mercy Medical Center, including economic credentialing. The “open letter” to the hospital’s board of trustees, administrators and Sisters of Mercy asked nine pointed questions, including the following:
Bill Senneff, chief operating officer of St. Edward Mercy, said the hospital would not comment on the anonymous ad. Senneff has told the Times Record that the board is reviewing the complaints and formulating a response, to be announced in coming weeks, and that the board recently tweaked the five-year-old Financial Conflict of Interest policy. Chris Hardin, a physician at the Westark Diagnostic Clinic in Fort Smith, and a trustee of the Arkansas Medical Society, said he was not one of the anonymous doctors who paid for the ad, but he supports their cause, as well as the doctors in Little Rock challenging Baptist Health’s economic credentialing policy. “I think they’re trying to educate the public about this,” Hardin said. “St. Ed’s has made it clear this policy has been on the books for five years, but they haven’t really enforced it because they don’t want to lose doctors and certification in various areas. “It’s not a very physician-friendly position to me,” Hardin said. At the heart of the issue is a new $15.4 million 24-bed inpatient orthopedic surgery hospital and urgent care center that will open in early 2009 in Fort Smith, providing more competition for St. Edward. River Valley Musculoskeletal Center has been planning the 34,000-square-foot expansion since 1998, said administrator Ed Hickman. “Our main concern with the conflict of interest is totally different than the Baptist case,” Hickman said. “(Fort Smith has) lost so many specialty physicians, the fear is that someone will go to the emergency room and there won’t be a specialist there.” He said that several physicians who were planning to leave Fort Smith are staying because of the new orthopedic facility. Hickman also said that residents who were seeking care in Tulsa, Oklahoma City and other cities in the region with comparable orthopedic centers can stay home for care when the new facility opens. Specialty hospitals are the wave of the future, Hickman said. “As Americans, we kind of like the convenience of it. You don’t want to go to a large campus and walk half an hour to a room.” Still, he understands why general hospitals feel the need to protect their financial interests. “I guess they felt they needed the policy to keep their competitiveness,” Hickman said. Fort Smith plastic surgeon Cole Goodman, who has privileges at St. Edward, said he had nothing to do with the ad, “but they were very pertinent questions and I hope they will be answered.” Goodman said the city has lost numerous specialists in the last few years, including two of five neurosurgeons, for a variety of reasons. “It’s become difficult to recruit physicians. The atmosphere here is considered to be physician unfriendly,” Goodman said. “If (the policy is) instituted, we won’t have any neurosurgeons at St. Edwards at all. I don’t see how economic credentialing helps patient care at all. I’m hoping the judge will see the light and rule against Baptist, and the situation here in Fort Smith will become moot. The patient is the one who’s going to suffer if the physicians aren’t allowed privileges.” Caption: Dr. Chris Hardin says the Sebastian County Medical Society is following the Little Rock Cardiology v. Baptist Health economic credentialing trial closely and has concerns about a similar financial conflict of interest policy instituted by St. Edward Mercy Medical Center in Fort Smith. June 2008 Tags:NoneBookmark:
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